The study enrolled 80 community-recruited volunteers with painful knee osteoarthritis (OA) who were randomly assigned to either the active treatment or control (placebo) group.

Penny Moss, Ph.D., with the School of Physiotherapy and Exercise Science at Curtin University in Perth, Australia, and co-author, told OTW, “Our research group’s overall focus is to unravel some of the physiological mechanisms which drive chronic pain. Osteoarthritis pain is of particular interest to us as it has previously been seen as predictably ‘nociceptive,’ driven by joint damage and so quite straight-forward to manage. Yet it has become clear that for some people, osteoarthritic pain is far more complex, does not respond to standard exercise or pharmaceutical management and may not directly reflect measurable joint damage. This may be why a proportion of people report minimal pain relief even after the joint has been replaced.”

“Even though it is increasingly clear that osteoarthritis pain is heterogeneous, medicine still tends to have a ‘one size fits all’ approach to OA. Although prescribing guidelines are changing, intervention studies continue to assume that OA is a single condition and so apply a small number of largely subjective measures to evaluate efficacy.”

“This randomized, placebo-controlled study aimed to use a more comprehensive approach to evaluating the efficacy of a widely-used Cox-2 inhibitor over a relatively short time-frame of 14 days. This particular intervention was chosen because of the particular importance of targeting its application so that its benefits outweigh risks for an individual patient. Our approach was different in that we used an array of outcomes measures to assess change from baseline to Day 14.”

“Etoricoxib clearly reduced participants’ pain with just a 14-day course, whether that was measured as subjective change in everyday pain or as change in evoked pain sensitivity. Interestingly, pain sensitivity was reduced even at sites distant from the OA knee, suggesting more than just a localized anti-inflammatory effect. We were particularly interested to find significantly reduced self-reported neuropathic-type symptoms as well.”

“It may be that Cox-2 NSAIDs [nonsteroidal anti-inflammatory drugs] have a more centralized effect than has been previously understood, however more data is needed to support or refute this finding. Certainly, just a short course had significant effects on pain, neuropathic-type pain, both local and widespread pain sensitivity and physical function. Although this study was not powered to stratify according to type of pain (neuropathic, nociceptive), there was clearly a range of responses amongst participants, suggesting that identification of pain type may be an important factor when deciding upon the most effective pain-relief approach for each individual. Further work is clearly needed.”

“Not all OA pain is nociceptive or simple, meaning that joint replacement may not be the best solution for all OA sufferers. Despite its understandably bad press, the benefits of Cox-2 NSAIDs may outweigh the risks in some individuals. Regardless, we need to thinking about a more comprehensive approach to the assessment of pain and function in people with OA pain so that we can stratify and treat most appropriately.”

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Osteoporosis Drug Helps Hip, Knee OA

Elizabeth Hofheinz, M.P.H., M.Ed. • Wed, September 18th, 2013

St George’s, University of London research has found that a drug normally given to osteoporosis sufferers could provide effective pain relief to patients with knee and hip osteoarthritis (OA). The researchers used existing studies to assess the effectiveness of a variety of bisphosphonates in patients suffering from osteoarthritis of the hand, knee, spine and hips.

The researchers looked at 3, 832 patients; in most cases these drugs showed limited pain relief. However, a few studies did show benefit; the bisphosphonate alendronate was found to be more effective for patients with hip osteoarthritis than existing pain relieving drugs. Moreover, the use of zoledronate and alendronate, specific forms of bisphosphonates, improved pain in patients with knee and hip osteoarthritis at six months—but longer term studies are needed.

Dr. Nidhi Sofat, lead researcher, said in the September 5, 2013 news release, “Osteoarthritis is the most common form of arthritis worldwide. It causes damage to bone and cartilage in the joints of affected people. Most treatment is focused around pain relief, as no robust treatments have been discovered that slow down the progression of the disease.

“Our study looked at whether there were any bisphosphonate drugs that have been shown to influence pain and/or disease progression that could be used in osteoarthritis treatment.

“We found that, generally, bisphosphonates are ineffective at managing pain associated with osteoarthritis. But zoledronate and alendronate, which are specific forms of bisphosphonates, do show the potential for effective pain management specifically in patients with knee and hip osteoarthritis.

Dr. Sofat told OTW, “We looked at the use of bisphosphonates in osteoarthritis since OA pain is a major public health concern and there are currently no long-term disease-modifying drugs that are used in OA with proven efficacy. Our most surprising finding was that although we reviewed data from 3, 832 patients in studies worldwide, there was high variability in patient selection and different studies looked at different sites of OA, including the hand, knees, hips and spine. Future studies are needed of bisphosphonates in osteoarthritis in clearly defined subsets of patients, coupled with robust radiographic analysis by cartilage integrity, BML size/composition, synovitis, joint space narrowing and evaluation of clinical biomarkers to more fully evaluate agents that could halt the onset and/or progression of osteoarthritis.”

Chair Yoga Is Effective Treatment for OA

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, January 31st, 2017

If you have osteoarthritis (OA), you may just have to go as far as, well, your chair, to get help. A new study, published in the current issue of the Journal of the American Geriatrics Society has found that chair yoga is effective at reducing pain and improving quality of life for those with OA in their lower extremities (hip, knee, ankle or foot). This research, undertaken by scientists from Florida Atlantic University (FAU), is the first randomized controlled trial to examine the effects of chair yoga on pain and physical function in older adults with osteoarthritis.

As indicated in the January 11, 2017 news release, “For the study, researchers randomly assigned 131 older adults with osteoarthritis to either the ‘Sit 'N' Fit Chair Yoga’ program developed by [yoga teacher] Kristine Lee or a health education program. Participants attended 45-minute sessions twice a week for 8 weeks. Researchers measured pain, pain interference (how it affects one's life), balance, gait speed, fatigue and functional ability, before, during and after the sessions. Results from the study found that participants in the chair yoga group, compared to those in the health education program, showed a greater reduction in pain and pain interference during their sessions, and that reduction in pain interference lasted for about three months after the 8-week chair yoga program was completed. The 8-week chair yoga program also was associated with reductions in fatigue and improvement in gait speed during the study session, but not post session.”

"With osteoarthritis-associated pain, there is interference in everyday living, limiting functional and social activities as well as diminishing life enjoyment," said Juyoung Park, Ph.D., co-author and co-principal investigator of the study, Hartford Geriatric Social Work Faculty Scholar and an associate professor in FAU's College for Design and Social Inquiry. "The effect of pain on everyday living is most directly captured by pain interference, and our findings demonstrate that chair yoga reduced pain interference in everyday activities."

Dr. Park told OTW, “We are able to provide the chair yoga program as one of the effective and safe nonpharmacological pain management options for older adults with osteoarthritis.

HA Injections Ease Knee Osteoarthritis Pain

Biloine W. Young • Fri, September 27th, 2013

Have a patient troubled with mild to moderate pain caused by knee osteoarthritis? Try intra-articular hyaluronic acid injections (HA). A new meta-analysis of 29 randomized studies involving more than 4, 500 patients with knee osteoarthritis (OA) found that intra-articular hyaluronic acid injections provided significant improvement in pain and function compared to saline injections. Medical News Today reported the study was published in the current issue of Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders.

Mark A. Snyder, M.D., an orthopedic surgeon from the TriHealth Orthopedic and Spine Institute in Cincinnati, Ohio, said, “The data set is consistent with what I and many other physicians have clinically observed for many years—HAs have been found to be safe, can help relieve knee pain from osteoarthritis, and are appropriate treatment for people with mild to moderate forms of the disease."

Neither HA or saline injections resulted in serious adverse events. Researchers found very large treatment effects between four and 26 weeks for knee pain and function which represented approximately a 50% improvement in pain and function from baseline with viscosupplementation. Improvements in knee pain and function with viscosupplementation were statistically superior compared to saline injections.

"Studies such as this are critical in helping physicians and patients make informed decisions, " said Snyder. "Currently, there are limited treatment options available to healthy people with mild to moderate OA. Access to HA treatments is a great option for those who are seeking help in staying active."

Osteoarthritis is a progressive disease that affects 27 million Americans. The most common joint to be affected is the knee. Advancing age, previous joint trauma and genetic predisposition are all risk factors while obesity contributes to the diseases’ progression.

Shu-Fen Sun, M.D. is with the Department of Physical Medicine and Rehabilitation at Kaohsiung Veterans General Hospital in Taiwan. A co-author on the study, Dr. Sun commented to OTW, “To date, there is no well-controlled trial comparing a single injection of hyaluronan (HA) for knee OA. This study compared the efficacy and safety of a single intra-articular injection of a novel crosslinked HA (HYAJOINT Plus) with a single injection of Synvisc-One in patients with knee OA.”

Dr. Sun told OTW, “Both a single injection of HYAJOINT Plus and Synvisc-One are safe and effective for 6 months in patients with knee OA. HYAJOINT Plus is superior to Synvisc-One in VAS pain reduction at 1, 3 and 6 months, with similar safety.”

Found: New Info on Knee Pain Distribution

Elizabeth Hofheinz, M.P.H., M.Ed. • Wed, October 26th, 2016

Having knee pain can also mean that you have “outside the knee” pain. Researchers have not had the full picture of the pain distribution and reasons for the pain, however. New research involving the Boston University School of Medicine, the University of Alabama School of Medicine, the University of California, San Francisco, and the Boston University School of Public Health has found that those with knee pain can indeed have pain in other joints, and that this pain doesn’t seem to follow a pattern.

David T. Felson, M.D., M.P.H. is professor of Medicine and Public Health at the Boston University School of Medicine. He told OTW, “We used the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative and followed nearly 3, 500 individuals who were 50-79 years who were at high risk of knee osteoarthritis (OA).”

“We looked into the distribution of joint complaints that develop in persons with knee pain and knee osteoarthritis. Many have suggested that adjacent joints (hips/ankles) are often affected because of biomechanical changes in gait due to knee pain. Our study found that persons with knee pain had more pain in other joints but that the distribution of that pain was random and not necessarily predominantly in adjacent joints (either ipsi or contralateral). These other symptoms suggest that biomechanical adaptations to knee pain are individualized but that the other pain that develops may well be due to changes in activities that spare loading to the affected knee. Orthopedists should take these complaints as possible evidence that the knee may be causing more problems that just in the knee.”